| NPI | 1700357480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LCDCII.161839) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| 171M00000X Case Manager/Care Coordinator (Licence: OH CMS) | |
| Enumeration Date | 2018-12-06 |
| Last Update Date | 2023-07-13 |